Work Place Injury Report Form Template for England and Wales

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Key Requirements PROMPT example:

Work Place Injury Report Form

"I need a Work Place Injury Report Form for our construction company's UK operations that includes specific sections for machinery-related incidents and meets RIDDOR requirements, with extra emphasis on photographic evidence collection and witness statements."

Document background
The Work Place Injury Report Form is a crucial document required under English and Welsh law for recording and reporting workplace accidents and injuries. It is designed to comply with RIDDOR 2013 requirements and the Health and Safety at Work Act 1974. Organizations must complete this form when workplace incidents occur, capturing detailed information about the injury, circumstances, and response measures. The form serves multiple purposes: meeting legal reporting obligations, supporting internal investigation processes, and providing documentation for potential insurance or legal proceedings. It should be completed as soon as practically possible after an incident occurs.
Suggested Sections

1. Employee Information: Personal details of injured person including name, job title, employee ID, department, and contact information

2. Incident Details: Date, time, location, and nature of injury/incident, including specific workplace area and circumstances

3. Injury Description: Detailed description of the injury including type, severity, body part affected, and immediate symptoms

4. Witness Information: Names and contact details of any witnesses to the incident, including their role and relationship to the incident

5. Initial Response: Details of first aid administered, personnel involved in response, and immediate actions taken following the incident

Optional Sections

1. Equipment Involved: Details of any machinery, tools, or equipment involved in the incident, including serial numbers and maintenance records

2. Environmental Factors: Description of environmental conditions that may have contributed to the incident, including weather, lighting, or workplace conditions

3. PPE Information: Details of Personal Protective Equipment in use at the time of incident, including condition and appropriateness

4. Third Party Involvement: Information about any contractors, visitors, or third parties involved in or affected by the incident

Suggested Schedules

1. Medical Report: Detailed medical assessment and treatment records from qualified healthcare professionals

2. Risk Assessment: Copy of relevant risk assessments for the task or area where incident occurred

3. Training Records: Documentation of relevant safety training and certifications completed by the injured person

4. Incident Scene Documentation: Photographs, diagrams, or sketches of the incident scene and any relevant equipment or materials

5. RIDDOR Report: Copy of the RIDDOR report if the incident meets reporting requirements

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant Industries
Relevant Teams
Relevant Roles
Industries

Health and Safety at Work etc. Act 1974 (HSWA): Primary legislation governing workplace health and safety in the UK, setting out general duties of employers to ensure health, safety and welfare of employees

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR): Specific regulations requiring employers to report and keep records of serious workplace accidents, occupational diseases and specified dangerous occurrences

Management of Health and Safety at Work Regulations 1999: Regulations requiring employers to assess and manage risks to their employees and others arising from work activities

Social Security (Claims and Payments) Regulations 1979: Regulations governing the process of making claims and payments related to workplace injuries and industrial accidents

UK General Data Protection Regulation (UK GDPR): Post-Brexit data protection legislation governing how personal data, including accident and injury information, must be processed and protected

Data Protection Act 2018: UK's implementation of data protection standards, particularly relevant for handling sensitive medical information in injury reports

Equality Act 2010: Legislation protecting workers from discrimination, including in cases where workplace injuries result in disabilities

Employment Rights Act 1996: Core employment legislation setting out basic employment rights, including those related to workplace injuries and health and safety

Construction (Design and Management) Regulations 2015: Industry-specific regulations for construction sector, including specific requirements for accident reporting and prevention

Social Security Administration Act 1992: Legislation governing the administration of social security benefits, including those related to workplace injuries

Limitation Act 1980: Sets statutory time limits for bringing legal claims, including personal injury claims arising from workplace accidents

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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